Prior Authorization

No later than March 1 of each year, the Department of Consumer and Business Services shall publish information about requests for prior authorization in a format that does not identify the insurer, in accordance with ORS 743B.250(8)(d).

The information presented here represents the commercial health insurance market in Oregon. This is limited to health benefit plan business as defined in ORS 743B.005(16).

De-identified prior authorization data for previous years can be found below.

Questions?

Contact:
DFR.DataTeam@dcbs.oregon.gov

2025

Standard Prior Authorization Requests	Number	Percentage
Total requests that were approved	342,367	80.8%
Requests that were approved after appeal	2,145
Requests for which the time frame for review was extended and the request was approved	4,408
Total requests that were denied	81,217	19.2%

Expedited Prior Authorization Requests	Number	Percentage
Total requests that were approved	16,686	71.2%
Requests for which the time frame for review was extended and the request was approved	539
Total requests that were denied	6,762	28.8%

Time elapsed (in business days) between submission of a request and determination by the insurer	Average	Range of Medians
Time elapsed for standard prior authorization	1.4	0.0 - 3.0
Time elapsed for expedited prior authorization	0.6	0.0 - 2.0

A “standard prior authorization" means a prior authorization request that is not an expedited prior authorization request.
An “expedited prior authorization" means a prior authorization that must be expedited in order to avoid jeopardizing the enrollee's life, health or ability to maintain or regain maximum function.
(See ORS 743B.250(14))

All information is reported by insurers to the Department and may be subject to change after March 1 as follow-up is done with insurers.